Botkin Hospital

Background. Despite a complex diagnostic evaluation, the cause of ischemic stroke (IS) remains unidentified in 23-40% of cases. The implementation of endovascular thrombectomy has created the opportunities for morphological analysis of thrombotic masses. Objective. To compare the histological structure of thrombi in patients (pts) with different subtypes of acute IS. Material and methods. For analysis, thrombotic masses were extracted from 107 pts with IS during aspiration thrombectomy. The relationships with clinical and procedural parameters were assessed. Results. Fractions of erythrocytes, fibrin, detritus and leukocytes in the extracted thrombi were comparable in patients with different subtypes of IS. In pts with cardioembolic IS and IS of undetermined etiology, the plasma cell count in thrombi was statistically significantly higher than in pts with atherothrombotic IS (10 (6;13) vs. 6 (4;9) number of cells, p=0.020; 10 (5;18) vs. 6 (4;9) number of cells, p=0.035, respectively). Conclusions. Quantitative examination of clot content may be used to distinguish between different IS subtypes. We suppose on the notion that the majority of IS of undetermined etiology was associated with cardioembolic source.

To evaluate the effect of intraoperative administration of 1g of tranexamic acid (TXA) on perioperative and postoperative outcomes in patients receiving antithrombotic therapy undergoing endoscopic enucleation of the prostate (EEP). This multicenter, prospective, observational study included 932 patients across 30 centers (December 2024-June 2025). Patients were divided into four groups based on TXA use and continuation or discontinuation of blood thinners during EEP. The primary endpoint was bleeding complications within 30 days, defined as a composite of transfusion, clot retention, bleeding requiring restart of continuous bladder washout (CBWO), or surgical reintervention to control hemostasis. Multivariable Logistic regression analysis identified independent predictors of bleeding complications. There were 534 patients in Group 1 (stopped blood thinners, no TXA given), 316 in Group 2 (on blood thinners, no TXA given), 69 in Group 3 (stopped blood thinners, TXA given), and 13 in Group 4 (on blood thinners, TXA given). Median total operative time was longest in Group 2 (88min [IQR 70-127]) and shortest in Group 3 (55min [IQR 39-69]). Hemostasis time was shortest in TXA groups (p < 0.001). Transfusions occurred in 0.6-7.7% and surgical reinterventions in 0.6-7.7% across groups (p < 0.001). At 3 months, urinary symptoms and continence were comparable. On multivariable analysis, TXA reduced the odds of bleeding complications (OR 0.17, p < 0.001), while ongoing anticoagulant therapy (OR 2.93, p = 0.01), dual therapy (OR 4.31, p < 0.001), and longer operative time (OR 1.01, p < 0.001) increased the odds. Intraoperative TXA might mitigate perioperative bleeding and potentially protect patients at higher hemorrhagic risk.

In recent years, reconstructive surgery strategies have been supplemented with innovative approaches aimed at developing tissue-engineered structures using autologous tissues and biodegradable scaffolds and matrices, the purpose of which is to reduce the risk of postoperative complications, on the one hand, while ensuring accelerated restoration of the structure and functions of organs, on the other hand. The review systematizes modern scientific trends in the field of tissue engineering of the urethra, focused on creation of biocompatible and functionally active tissue-engineered structures using achievements of cellular technologies and materials science. Particular attention is paid to describing the mechanisms and ways of forming a complete and functional three-dimensional structure of the urethra, including the use oforganoids. It is expected that this strategy will contribute to the development of personalized therapeutic approaches and improved clinical outcomes in the patients with urological diseases.

Introduction. Overactive bladder (OAB) de novo, while not considered a life-threatening condition, can be a significant issue for the patient. Moreover, urge urinary incontinence is more difficult to manage than stress urinary incontinence (SUI). Even in the absence of incontinence, this condition can significantly reduce the quality of life and satisfaction with the intervention. Objective. To summarise the existing data on OAB de novo after midurethral loop implantation (MULI) and to analyse the risk factors for the development of this condition and the existing options for correction, with an assessment of the prospects for further clinical trials. Materials &amp; methods. The search for publications was performed on national and international abstract databases eLibrary.Ru, Pubmed, Cochrane Library. The following keywords were used for the search: ‘de novo hyperactivity’, ‘de novo urgency’, ‘de novo OAB’, ‘midurethral sling complications’, ‘hyperactivity after sling implantation’. A chronological limit of 20 years (2004-2024) was used. A total of 317 sources (publications from peer-reviewed periodicals) were retrieved. 234 publications were excluded after reading the abstract because they did not fit the assigned topic. For further analysis, 24 papers were selected from the remaining works that met the criteria of scientific reliability. Results. According to the world literature, OAB de novo appears in 6.4% to 11.5% of patients who underwent MULI. However, there are studies where the above condition was observed in 41% of cases at 20-year follow-up. The underlying causes of involuntary bladder contractions may include various neurological diseases, inflammatory process, decreased activity of pelvic floor muscle tone inhibitors, increased neurotransmitter release, increased sensitivity to neurotransmitters, increased afferent innervation and infravesical obstruction. The mechanism for the development of OAB de novo remains an ongoing challenge. Conclusion. Any surgical intervention to correct SUI may lead to adverse effects, in particular OAB de novo. Information on the prevalence of this condition, as well as on approaches to its treatment, varies from study to study. There is a high percentage of underestimation of urgency symptoms at the preoperative stage. Therefore, a more detailed history should be taken and targeted investigations should be carried out at the initial consultation. OAB de novo following MULI significantly reduces patients' quality of life and satisfaction with the treatment.

The incidence of endometrial atypical hyperplasia (EAH) and cancer (EC) shows a steady increase every year, which is associated with an increase in the prevalence of their risk factors, primarily the “nonsteroidal triad”: obesity, diabetes mellitus, and metabolic syndrome. In the context of the demographic crisis and the postponement of reproductive plans for the sake of self-realization, the issue of fertility preservation with a favorable prognosis in young patients with EAH and early stages of EC of the low-risk group becomes especially relevant. Significant advancements in classification approaches, with the isolation of EC molecular subtypes that determine prognosis, and in diagnostics, with the development of a new method of liquid-based cytology combined with ultrasound examination, help clearly stratify patients at the outpatient stage into a cohort suitable for organ-preserving therapy. A review of the results of systematic reviews and meta-analyses proves that to date, oral progestins or gonadotropin-releasing hormone agonists, the installation of a levonorgestrel-containing intrauterine system alone or in various combinations are justified alternatives to radical surgical treatment in patients with precancer and EC with minimal invasion of the myometrium according to expert-level ultrasound or magnetic resonance imaging, provided that complete drug pathomorphosis of foci is achieved with the prompt implementation of reproductive plans with the thorough monitoring by an obstetrician-gynecologist and a reproductive specialist.

Abstract Background and Aims The study of the metabolites in patients with CKD on hemodialysis, is of great interest due to the involvement their in the development of typical complications (cardiovascular diseases, vascular calcification, infection s and so on), and deciding the appropriate treatment. The resulted metabolic disturbances associated with the severity of the disease mirror the phenotype of an organism and provide a detailed understanding of the metabolic processes involved in a disease. In addition, the use of synbiotics (probiotics and prebiotics) can significantly affect the intestinal microflora and metabolites. The patients included in the study were clinically stable (men and women) with HD for at least 6 months before the study. The patients underwent a standard haemodialysis procedure 3 times a week. The aim of this study was to investigate the blood metabolic profile in patients on hemodialysis and the effect of the treatment with with “Maxilac”, a synbiotic drug on the blood metabolic profile. Method In our study we included 22 patients, age 53 ± 12.4 years (12 f/10 m), who received hemodialysis at our nephrology center. The study of metabolites included 2 stages before taking “Maxilac” and after two months. Blood samples were analyzed using 1H-nuclear magnetic resonance spectroscopy focusing on low-molecular-weight metabolites. We used standard statistical methods and OPLS-DA analyses employing the MetaboAnalyst 5.0 platform. Results A total of 55 metabolites were identified in serum samples from hemodialysis patients with CKD. The t-test demonstrated statistically significant changes in several metabolites after “Maxilac” treatment, including threonine, hippurate, myoinosotole, xanthosine, carnitine, acetone, aspartate, formate, proline, creatinine, 2-oxoisocaproate, lactate (Fig. 1). The oPLS-DA statistical analysis score plot is presented in the Fig. 2 with component changes including 15 metabolites with significant changes in concentration before and after “Maxilac” treatment. These metabolites included threonine, formate, acetone, xanthosine, aspartate, acetate, proline, myoinositol, inosine, 1-methylhystidine, carnitine, lactate, 2-oxoisocaproate, dimethylamine, 3-methyl-2-oxovalerate. These findings indicate that “Maxilac” therapy induces specific metabolic alterations in patients on hemodialysis, predominantly impacting amino acid, purine, and glucose metabolism. Conclusion The use of “Maxilac” in patients on hemodialysis leads to an improvement in the metabolic profile.

Doxofylline, a xanthine derivative introduced in 1987, was developed as an alternative to theophylline for the treatment of chronic respiratory disease, including chronic obstructive pulmonary disease and bronchial asthma, but also a promising agent with therapeutic potential, unique pharmacological profile, improved safety and tolerability, potential to decrease corticosteroid dependence and applicability in diverse healthcare settings, including resource-limited environments. The present review examines the utility of doxofylline as an effective bronchodilator, highlighting its improved tolerability profile, minimal drug interactions and distinct pharmacological activities, including its roles as a phosphodiesterase inhibitor, adenosine receptor antagonist and β-adrenergic receptor agonist, alongside its bronchodilator, antitussive and anti-inflammatory properties. The present review performed a comprehensive analysis of literature and a comparative evaluation of relevant clinical trials. By contrast with theophylline, whose clinical use has diminished due to its narrow therapeutic window and notable side effects, doxofylline demonstrates a more favorable safety profile and wider therapeutic range. Doxofylline not only enhances spirometric values and reduces the need for salbutamol administration but also exhibits fewer adverse effects, contributing to improved patient tolerance and adherence to treatment. Clinical findings further suggest significant improvements in lung function, exercise capacity and quality of life among patients treated with doxofylline. These results underscore its potential as a viable long-term therapeutic option, particularly in resource-limited settings, where it may reduce corticosteroid dependency and provide an effective, affordable and safer alternative to theophylline.